Cerebrovascular Events in Patients Undergoing Transfemoral Transcatheter Aortic Valve Implantation: A Pooled Patient-Level Study

Overview

Journal J Am Heart Assoc

Specialty Cardiology & Vascular Diseases

Date 2024 Aug 27

PMID 39190595

Authors

Astrid C van Nieuwkerk

Hugo M Aarts

Kimberley I Hemelrijk

Cristobal Urbano Carrillo

Didier Tchetche

Fabio S de Brito Jr

Marco Barbanti

Ran Kornowski

Azeem Latib

Augusto DOnofrio

Flavio Ribichini

Sergio Garcia-Blas

Nicolas Dumonteil

Alexandre Abizaid

Samantha Sartori

Paola DErrigo

Giuseppe Tarantini

Mattia Lunardi

Katia Orvin

Matteo Pagnesi

Felipe Navarro

George Dangas

Roxana Mehran

Ronak Delewi

Affiliations

Soon will be listed here.

Abstract

Background: Cerebrovascular events remain one of the most devastating complications of transcatheter aortic valve implantation (TAVI). Data from real-world contemporary cohorts on longitudinal trends and outcomes remain limited. The aim of this study was to assess incidence, temporal trends, predictors, and outcomes of cerebrovascular events following transfemoral TAVI.

Methods And Results: The CENTER2 (Cerebrovascular Events in Patients Undergoing Transcatheter Aortic Valve Implantation With Balloon-Expandable Valves Versus Self-Expandable Valves 2) study includes patients undergoing TAVI between 2007 and 2022. The database contains pooled patient-level data from 10 clinical studies. A total of 24 305 patients underwent transfemoral TAVI (mean age 81.5±6.7 years, 56% women, median Society of Thoracic Surgeon Predicted Risk of Mortality 4.9% [3.1%-8.5%]). Of these patients, 2.2% (n=534) experienced stroke in the first 30 days after TAVI, and 40 (0.4%) had a transient ischemic attack. Stroke rates remained stable during the treatment period (2007-2010: 2.1%, 2011-2014: 2.5%, 2015-2018: 2.1%, 2019-2022: 2.1%; =0.28). Moreover, 30-day cerebrovascular event rates were similar across Society of Thoracic Surgeon Predicted Risk of Mortality risk categories: 2.1% in low-risk, 2.6% in intermediate-risk, and 2.5% in high-risk patients (=0.21). Mortality was higher in patients with 30-day stroke than without at 30 days (20.3% versus 4.7%; odds ratio, 5.1 [95% CI, 4.1-6.5]; <0.001) and at 1 year (44.1% versus 15.0%; hazard ratio, 3.5 [95% CI, 3.0-4.2]; <0.001). One-year mortality rates for stroke did not decline over time (2007-2010: 46.9%, 2011-2014: 46.0%, 2015-2018: 43.0%, 2019-2022: 39.1%; =0.32). At 1 year, 7.0% of patients undergoing TAVI had a stroke.

Conclusions: In 24 305 patients who underwent transfemoral TAVI, 30-day cerebrovascular event incidence remained ≈ 2.2% between 2007 and 2022. Thirty-day stroke rates were similar throughout Society of Thoracic Surgeon Predicted Risk of Mortality risk categories. Mortality rates after stroke remain high.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03588247.

Citing Articles

Cerebral blood flow and cognitive functioning in patients undergoing transcatheter aortic valve implantation.

van Nieuwkerk A, Hemelrijk K, Aarts H, Leeuwis A, Majoie C, Daemen M EClinicalMedicine. 2025; 81:103092.

PMID: 40026830 PMC: 11872408. DOI: 10.1016/j.eclinm.2025.103092.

Protruding and Ulcerated Aortic Atheromas as Predictors of Periprocedural Ischemic Stroke Post-Transcatheter Aortic Valve Replacement.

Kikuchi S, Trimaille A, Carmona A, Truong D, Matsushita K, Marchandot B JACC Asia. 2025; 5(2):258-269.

PMID: 39967216 PMC: 11840235. DOI: 10.1016/j.jacasi.2024.10.020.

2024 Update on Cerebral Embolic Protection After Transcatheter Aortic Valve Replacement.

Gasior T J Clin Med. 2024; 13(23).

PMID: 39685715 PMC: 11642540. DOI: 10.3390/jcm13237256.

Spotlight on Neurocardiology: An Emerging Field Gaining Traction Among Neurologists and Cardiologists.

Sposato L, Gupta A, Wu K J Am Heart Assoc. 2024; 13(17):e038026.

PMID: 39190617 PMC: 11646525. DOI: 10.1161/JAHA.124.038026.

Stroke in Patients Undergoing Transcatheter Aortic Valve Replacement: Embracing the Unpredictable.

Elkaryoni A, Saad M J Am Heart Assoc. 2024; 13(17):e036240.

PMID: 39190597 PMC: 11646516. DOI: 10.1161/JAHA.124.036240.

References

De Backer O, Butt J, Wong Y, Torp-Pedersen C, Terkelsen C, Nissen H . Early and late risk of ischemic stroke after TAVR as compared to a nationwide background population. Clin Res Cardiol. 2019; 109(7):791-801. DOI: 10.1007/s00392-019-01565-0. View

Mack M, Leon M, Thourani V, Makkar R, Kodali S, Russo M . Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients. N Engl J Med. 2019; 380(18):1695-1705. DOI: 10.1056/NEJMoa1814052. View

Mourikis P, Dannenberg L, Zako S, Helten C, MPembele R, Richter H . Impact of Transcatheter Aortic Valve Implantation on Thrombin Generation and Platelet Function. Thromb Haemost. 2021; 121(10):1310-1316. DOI: 10.1055/s-0041-1725190. View

Arsalan M, Weferling M, Hecker F, Filardo G, Kim W, Pollock B . TAVI risk scoring using established versus new scoring systems: role of the new STS/ACC model. EuroIntervention. 2017; 13(13):1520-1526. DOI: 10.4244/EIJ-D-17-00421. View

Kappetein A, Head S, Genereux P, Piazza N, Van Mieghem N, Blackstone E . Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. EuroIntervention. 2012; 8(7):782-95. DOI: 10.4244/EIJV8I7A121. View

Brouwer J, Nijenhuis V, Delewi R, Hermanides R, Holvoet W, Dubois C . Aspirin with or without Clopidogrel after Transcatheter Aortic-Valve Implantation. N Engl J Med. 2020; 383(15):1447-1457. DOI: 10.1056/NEJMoa2017815. View

Van Mieghem N, Schipper M, Ladich E, Faqiri E, van der Boon R, Randjgari A . Histopathology of embolic debris captured during transcatheter aortic valve replacement. Circulation. 2013; 127(22):2194-201. DOI: 10.1161/CIRCULATIONAHA.112.001091. View

Genereux P, Piazza N, Alu M, Nazif T, Hahn R, Pibarot P . Valve Academic Research Consortium 3: updated endpoint definitions for aortic valve clinical research. Eur Heart J. 2021; 42(19):1825-1857. DOI: 10.1093/eurheartj/ehaa799. View

Vlastra W, van den Boogert T, Krommenhoek T, Bronzwaer A, Mutsaerts H, Achterberg H . Aortic valve calcification volumes and chronic brain infarctions in patients undergoing transcatheter aortic valve implantation. Int J Cardiovasc Imaging. 2019; 35(11):2123-2133. PMC: 6805808. DOI: 10.1007/s10554-019-01663-0. View

10.

Alkhouli M, Alqahtani F, Harris A, Hohmann S, Rihal C . Management Patterns and Outcomes of Acute Ischemic Stroke Complicating Transcatheter Aortic Valve Replacement. Stroke. 2021; 52(3):e94-e96. DOI: 10.1161/STROKEAHA.120.032376. View

11.

Carroll J, Mack M, Vemulapalli S, Herrmann H, Gleason T, Hanzel G . STS-ACC TVT Registry of Transcatheter Aortic Valve Replacement. J Am Coll Cardiol. 2020; 76(21):2492-2516. DOI: 10.1016/j.jacc.2020.09.595. View

12.

Ryan T, Grindal A, Jinah R, Um K, Vadakken M, Pandey A . New-Onset Atrial Fibrillation After Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis. JACC Cardiovasc Interv. 2022; 15(6):603-613. DOI: 10.1016/j.jcin.2022.01.018. View

13.

Valle J, Li Z, Kosinski A, Nelson A, Vemulapalli S, Cleveland J . Dissemination of Transcatheter Aortic Valve Replacement in the United States. J Am Coll Cardiol. 2021; 78(8):794-806. DOI: 10.1016/j.jacc.2021.06.028. View

14.

Foley M, Hall K, Howard J, Ahmad Y, Gandhi M, Mahboobani S . Aortic Valve Calcium Score Is Associated With Acute Stroke in Transcatheter Aortic Valve Replacement Patients. J Soc Cardiovasc Angiogr Interv. 2022; 1(4):100349. PMC: 9337994. DOI: 10.1016/j.jscai.2022.100349. View

15.

Toyoda K, Ninomiya T . Stroke and cerebrovascular diseases in patients with chronic kidney disease. Lancet Neurol. 2014; 13(8):823-33. DOI: 10.1016/S1474-4422(14)70026-2. View

16.

Huded C, Tuzcu E, Krishnaswamy A, Mick S, Kleiman N, Svensson L . Association Between Transcatheter Aortic Valve Replacement and Early Postprocedural Stroke. JAMA. 2019; 321(23):2306-2315. PMC: 6582268. DOI: 10.1001/jama.2019.7525. View

17.

Thourani V, OBrien S, Kelly J, Cohen D, Peterson E, Mack M . Development and Application of a Risk Prediction Model for In-Hospital Stroke After Transcatheter Aortic Valve Replacement: A Report From The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. Ann Thorac Surg. 2018; 107(4):1097-1103. PMC: 6726434. DOI: 10.1016/j.athoracsur.2018.11.013. View

18.

Vlastra W, Jimenez-Quevedo P, Tchetche D, Chandrasekhar J, de Brito Jr F, Barbanti M . Predictors, Incidence, and Outcomes of Patients Undergoing Transfemoral Transcatheter Aortic Valve Implantation Complicated by Stroke. Circ Cardiovasc Interv. 2019; 12(3):e007546. DOI: 10.1161/CIRCINTERVENTIONS.118.007546. View

19.

Kapadia S, Makkar R, Leon M, Abdel-Wahab M, Waggoner T, Massberg S . Cerebral Embolic Protection during Transcatheter Aortic-Valve Replacement. N Engl J Med. 2022; 387(14):1253-1263. DOI: 10.1056/NEJMoa2204961. View

20.

Collet J, Van Belle E, Thiele H, Berti S, Lhermusier T, Manigold T . Apixaban vs. standard of care after transcatheter aortic valve implantation: the ATLANTIS trial. Eur Heart J. 2022; 43(29):2783-2797. DOI: 10.1093/eurheartj/ehac242. View